Irizarry Olga Corazón, Lewey Jennifer, McCallister Camille, Koelper Nathanael C, Arany Zoltan, Levine Lisa D
Department of Obstetrics & Gynecology, St. Luke's University Health Network, Bethlehem, PA, United States of America.
Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America.
Am Heart J Plus. 2024 Oct 11;47:100472. doi: 10.1016/j.ahjo.2024.100472. eCollection 2024 Nov.
To evaluate patient-level differences and decision making surrounding subsequent pregnancies (SSP) after peripartum cardiomyopathy (PPCM).
Mixed methods approach to evaluate quantitative demographic and clinical differences between patients with and without a SSP and to qualitatively describe the decision-making regarding a SSP with a survey component.
SETTING/PARTICIPANTS: 220 PPCM cases within the University of Pennsylvania Health System.
Demographic, clinical and obstetrical outcomes.
73 patients (33 %) had a SSP, 37 with a live birth. Those with a SSP were more likely to self-identify as Black (70 % vs. 52 %; = 0.04), be nulliparous in index pregnancy (68 % vs. 45 %, = 0.02), were younger at diagnosis (24.3 vs. 30.5 years; < 0.01), and a higher left ventricular ejection fraction (LVEF) at diagnosis (35 % vs. 27.5 %; = 0.03) compared to patients without a SSP. There was no difference in recovery rates of LVEF (62 % vs. 50 %, = 0.17), or need for LVAD, transplant, or death. 22 patients completed the survey (representing 44 SSPs): 41 % of SSPs ( = 18) resulted in termination, 18 % ( = 8) in a first/s trimester loss, and 41 % (n = 18) in a live-born delivery. All patients who elected termination indicated risk of recurrence/worsening heart failure to be a motivating factor.
Less than 20 % of patients in this single-center, multi-racial cohort had a SSP and delivery after PPCM with fear of recurrence as a large driver in this decision. Patients with a SSP were younger with a higher EF at diagnosis but ultimately had similar cardiac outcomes as patients without a SSP.
评估产后心肌病（PPCM）后患者层面的差异以及后续妊娠（SSP）相关的决策情况。
采用混合方法评估有或无SSP的患者之间的定量人口统计学和临床差异，并通过一项调查组件定性描述关于SSP的决策过程。
设置/参与者：宾夕法尼亚大学医疗系统内的220例PPCM病例。
人口统计学、临床和产科结局。
73例患者（33%）有SSP，其中37例活产。有SSP的患者更有可能自我认定为黑人（70%对52%；P = 0.04），在首次妊娠时为初产妇（68%对45%，P = 0.02），诊断时年龄更小（24.3岁对30.5岁；P < 0.01），与无SSP的患者相比，诊断时左心室射血分数（LVEF）更高（35%对27.5%；P = 0.03）。LVEF的恢复率（62%对50%，P = 0.17），或使用左心室辅助装置（LVAD）、移植或死亡的需求没有差异。22例患者完成了调查（代表44次SSP）：41%的SSP（n = 18）导致终止妊娠，18%（n = 8）在孕早期/中期流产，41%（n = 18）活产分娩。所有选择终止妊娠的患者均表示复发/心力衰竭恶化的风险是一个推动因素。
在这个单中心、多种族队列中，不到20%的患者在PPCM后有SSP并分娩，对复发的恐惧是这一决策的主要驱动因素。有SSP的患者诊断时更年轻，EF更高，但最终心脏结局与无SSP的患者相似。
